[Role of retroperitoneal laparoscopic nephroureterectomy in the current treatment of upper urinary tract urothelial carcinoma]. / Locul nefroureterectomiei laparoscopice retroperitoneale in tratamentul actual al carcinomului urotelial de cai urinare superioare.

INTRODUCTION: Nowadays, the standard treatment for upper tract transitional cell carcinoma is open nephroureterectomy, by double lumbar and iliac approach, with peri-meat bladder cuff excision. Since the first laparoscopic nephroureterectomy was performed, several surgical teams were interested by this approach for the treatment of the upper tract transitional cell carcinoma. OBJECTIVE: To plead for retro-peritoneoscopic nephroureterectomy and to assess the surgical indications. MATERIAL AND METHOD: Were analyzed the results of the recent published series on nephroureterectomy for upper urinary tract transitional cell carcinoma. Were included studies on conventional, laparoscopic and retro-peritoneoscopic nephroureterectomy, with at least 10 cases, published after 2000. RESULTS: The advantages of retro-peritoneoscopic nephroureterectomy are: minimum blood loss, reduced analgesic intake, a shorter hospital stay and a faster return to previous activities, lower rate of intra- or postoperative complications compared with trans-peritoneal laparoscopy or conventional surgery. With a proper case selection the oncologic safety of the retro-peritoneoscopy is equivalent with open surgery. CONCLUSIONS: On short term, retro-peritoneoscopic approach shows similar oncological outcome with other techniques. Retroperitoneal laparoscopic nephroureterectomy is a viable alternative to conventional or trans-peritoneoscopic procedure, with clear cut benefits for the patient. Retro-peritoneoscopy is associated with a low morbidity.

The evolution of weight and body composition in renal transplant recipients: Two-year longitudinal study.

UNLABELLED: Previous series have reported weight gain after kidney transplantation. However few studies have investigated the body composition after kidney transplantation, particularly during longitudinal follow-up. In this prospective study, we assessed the changes in body composition after kidney transplantation. We also analyzed the effect of steroid withdrawal from the immunosuppressive regimen on weight gain and body composition. METHODS: Thirty-eight cadaveric kidney transplant recipients were followed for 2 years posttransplant. Total and segmental body composition were measured by dual energy X-ray absorptiometry (DEXA) at the time of transplantation as well as 3, 6, 12, and 24 months later. RESULTS: In 28 patients (group A), prednisone was stopped by month 6, whereas, in 10 patients (group B), it was continued throughout the study. In the overall patient group, there were no significant changes in body weight. However, a trend to increased weight was observed in group B. In this group, patients showed an early increase in total body fat with a central accumulation of fat mass that was maintained during the follow-up period. On the other hand, total lean mass increased significantly in group A but did not change significantly in group B. CONCLUSION: In summary, overall the group showed no major changes in body weight during the 2 years after transplantation. Steroid withdrawal in kidney transplant recipients may have a significant positive effect on body composition.